Healthcare Reform Increases Medicare Reimbursement for Midwives

Beginning this month, a provision set forth in the federal health care reform bill takes effect that will increase Medicare reimbursement rates for certified nurse midwives to the levels that physicians receive for the same services. Although the vast majority of patients on Medicare are older than child-birthing age, the government program is a standard-setter for the health insurance industry as a whole.

A certified nurse-midwife (CNM) is a registered nurse who has successfully completed a program of study and clinical experience in nurse-midwifery. The nurse-midwife must be currently licensed to practice in the State as a registered professional nurse and must meet one of several requirements set forth by the Centers for Medicare and Medicaid Services (CMS), including certification by the American College of Nurse-Midwives.

Both Medicare and Medicaid will reimburse certified nurse-midwives for services, but previously CNM’s received reimbursement through Medicare at 65% that of a physician providing the same service. The provision for equal pay begins immediately for those who are Medicare-eligible due to a disability and to military families.

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CNM’s can perform as primary care providers, providing comprehensive gynecologic and maternity care. Services provided can include annual gynecological exams, family planning, labor and delivery support, breastfeeding assistance, and even menopausal management. These professionals work in a variety of settings including private practices, hospitals, birth centers, and health clinics.

Many consumers choose midwifes for low-risk pregnancies because of lower costs. A statewide survey in Pennsylvania, for example, found that the average charge of a midwife delivery at a birth center is $4,600 compared to $7,737 for a vaginal delivery at a hospital.

Christine Haas, executive director of Pittsburgh's Midwife Center for Birth and Women's Health, said, "The new law will help make midwife and birth center services more accessible and viable, which will ultimately lower costs to the health-care system as well as improve outcomes."

To find a CNM in your area who accepts Medicare, visit www.medicare.gov and search under “Other Healthcare Professional” for Nurse-Midwife.